1. Nutrition & Exercise During Pregnancy

2. Why is This Relevant to Me? Everyone knows someone who is pregnant/going to become pregnant Diet and Exercise are important for people who are not pregnant. Health problems are on the rise

3. Weight Gain During Pregnancy Weight gain depends on many factors: Rate of weight gain Maternal age Appetite Pre-pregnancy body mass index Where the weight goes? Baby-7.5 lbs Breast growth- 2lbs Maternal stores- 7lbs Placenta 1.5 lbs Uterus growth- 2lbs Amniotic fluid- 2 lbs Blood – 4 lbs Body fluids- 4 lbs

4. What is a BMI? BMI- Body Mass Index (Weight/Height 2 ) x 703 Applies to adult men and women ClassificationBMI Underweight<18.5 Normal weight18.5-24.9 Overweight25-29.9 Obesity>30

5. Weight Gain During Pregnancy Weight should be gained gradually First trimester 1-4 lbs total during the first 3 months Second & Third Trimester 2 to 4 pounds per month during the 4 th to 9 th months Most weight gained in last three months Avoid weight loss during pregnancy even if obese Weight gain during the 2 nd trimester predicts birth weight Seek proper weight before pregnancy

6. Effects of Starting BMI Underweight (BMI <18.5) Increased risk of preterm delivery Low birth weight baby Iron deficiency anemia Nutritional requirements low Overweight (BMI ≥25) Gestational diabetes Gestational hypertension C-Section Delivery Birth defects (neural tube defects) Fetal death or miscarriage Postpartum effects (hemorrhage, wound infection, depression) Increase chance of childhood obesity

7. Nutrition During Pregnancy Most pregnant women need 2,200-2,900 calories Energy Requirements No different than non- pregnant women until the 2 nd trimester 340 kcal in the 2 nd trimester 452 kcal in the 3 rd trimester Variety of foods Choose nutrient-dense foods/ limit energy-dense foods www.mypryamid.gov

8. How much is that increase? 340 Calories 8oz low-fat plain yogurt mixed with 1/2 cup raspberries and 1 tbs honey (205 cals) One hard-boiled egg with a slice whole grain toast (130 cals) 452 Calories 2 oz turkey burger, 1/4 cup avocado, 1/4 cup grilled onions on one slice whole-grain bread (240 cals) 1/2 whole grain English muffin, toasted; 2 tbs pizza sauce, 2 oz low-fat mozzarella (190 cals)

9. Dietary Guidelines for Non-Pregnant Individuals USDA 2005 Dietary Guideline New one set for 2010 Based on 2,000 calorie diet Fruit Group 2 cups(4 servings) Vegetable Group 2.5 cups (5 servings) Grain Group 6 ounces Meat and Beans Group 5.5 ounces Milk Group 3 cups Oils 24 grams (6tsp)

10. Nutrition During Pregnancy Whole grains Bread, cereals, pasta, brown rice Whole/Canned/Frozen Fruits Apples, pears, peaches, nectarines, melon Stay away from acidic fruits such as oranges, pineapples, lemons, and limes Vegetables Leafy greens, bell pepper, eggplant, squash, and mushrooms Lean protein from plant and animal sources Tofu, nuts, seeds, lentils, beans, red meat, chicken, turkey, fish and pork Low-fat dairy Milk, cheese and yogurt Healthful fats Canola oil, walnuts, almonds, avocadoes, and fish

11. Supplementation Prenatal multivitamin is advised before pregnancy for Women with multiple births Women with HIV Women taking drugs Women eating little/no animal products Multivitamin used to complement not to substitute for a good diet Early supplementation has shown to decrease risk for preeclampsia

12. Foods to Avoid During Pregnancy Minimize beverages/sports drinks or foods with: High sugar content High Sodium Raw Eggs Unpasteurized juices or dairy products Undercooked meat, poultry, and fish Deli meats Raw vegetable sprouts Soft Cheeses Fish

13. Mercury Controversial topic High amount in large predatory fish (<100g per week) King Mackerel Pike Shark Walleye Barracuda Large Tuna Tuna No more than twice per week

14. Potential Pathogen/Food Safety Pathogens: Listeria Airborne pathogen Can grow at refrigeration temperatures Deli meats, unpasteurized milk, refrigerated and ready to eat products Toxoplasma gondii Can pass through placenta Feces of cats Contaminated/undercooked meat, unwashed fruits, unpasteurized milk, contaminated water Food safety tips: Wash fruits and vegetables Heat meat to steaming

15. Omega 3-Fatty Acids/DHA Essential fatty acids Needs to come from diet Body cannot make them Child growth, development, & health Visual & Cognitive Development Present in breast milk 200 milligrams/day Sources Fish Fish oil Canola Oil Flax

16. DHA Recommendation Study Goal: Develop recommendations on dietary fat intake in pregnancy and lactation Results Dietary fat intake during pregnancy and lactation same as the general population Omega-3 PUFA deposited in brain/other tissues during fetal and postnatal life Maternal intake of omega-3 PUFA have visual and cognitive development outcomes for the infant Conclusion Dietary intake of 200 milligrams/ day 1-2 portions of sea fish/week or consumption of flaxseed or canola oils

17. Calcium & Vitamin D Calcium Development of baby’s teeth, bones, heart, nerves, and muscles 1,000 milligrams/day Calcium before and during pregnancy Sources Low-fat or fat-free milk Yogurt Cheese Calcium-fortified cereals Calcium-fortified juices Vitamin D Reduce infection in pregnancy Reduce preeclampsia Increase absorption of Calcium

18. Maternal Vitamin D Deficiency and Risk for Preeclampsia Methods Case study of Vitamin D levels in preeclamptic women >16 wks compared to non-preeclamptic women Results As maternal serum vitamin D concentrations increased, risk of preeclampsia decreased. Neonates born to preeclamptic mothers more likely to have poor Vitamin D status than neonates of controls Conclusion Maternal Vitamin D deficiency at less than 22 weeks was a risk factor for preeclampsia

19. Folate Reduces risk of birth defects affecting the spinal cord Needed to produce blood and protein for the baby. Advised to increase intake when planning or capable of pregnancy. 400 micrograms/day for non-pregnant women 600 micrograms/day for pregnant women Sources Cereals Pasta Bread Supplements

20. Folic Acid Fortification and Neural Birth Defects Introduction Mandatory fortification Increase by 30–70% of folic acid 87% due to Spina Bifida Results Before fortification Neural tube defects was 1.85 per 1000 live births Introduction of fortification Neural tube defects was 1.07 per 1000 live birth After fortification Neural tube defects was.95 per 1000 live births Conclusion Significant decline of 49% in incidence of neural tube defects

21. Iron Pregnant women are at high risk for anemia Iron deficiency Helps red blood cells deliver oxygen to the baby Non-pregnant women: 15-18 milligrams/day Pregnant women 27 milligrams/day Sources Spinach Kale Leafy greens Beans Fortified Cereals Red Meat Chicken Fish

22. PICA Ingestion of non-food items are foods in higher amounts Associated with Iron deficiency Cravings for taste, smell, or texture Complications Depend on substance eaten GI disturbance Excess weight gain Hyperglycemia High Blood Pressure Metabolic Alkalosis

23. Exercise During Pregnancy Requirements Then ACOG Should not exceed 140 beats/minute Strenuous exercise ≤15 minutes Now ACOG Moderate exercise ≥30 minutes Most days of the week Changes in body: Balance Joints Heart Rate Seek Healthcare professional

24. Benefits of Exercising Mother Improved cardiovascular function Limited pregnancy weight gain Decreased musculoskeletal discomfort Reduced muscle cramps Reduced lower limb swelling Mood stability Fetus Decreased fat mass Improved stress tolerance Advanced neurobehavioral maturation

25. Types of Exercise Beginners Walking Cycling Swimming Aerobics Exercisers Running Strength training

26. Exercises to Avoid Downhill snow skiing Contact sport Football Basketball Ice Hockey Soccer Scuba Diving Gymnastics Horseback riding Standing for long periods of time

27. Conclusion Proper weight gain is important in maintaining the health and well being of both the mother and the fetus Iron, Vitamin D, omega 3 fatty acids, and Folic Acid are important to supplement during pregnancy Exercise during pregnancy is beneficial not only for the mother but for the fetus These nutrition and exercise recommendations are important for pregnant women but can be maintained after pregnancy for a healthy lifestyle